JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
PMFS Daily Health Questionnaire
Please submit the health questionnaire NO LATER THAN 7:30am.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Today's Date
*
MM
/
DD
/
YYYY
Student Name
*
Your answer
Class
*
Pre-K - Little House
Pre-K - Journey's End
K
1
2
3/4
5/6
Does your child now, or within the past 24 hours, have a temperature of 100+, feel chills or feverish, or have nausea, vomiting or diarrhea?
*
Yes, I understand my child must stay home for 24 hours after the symptoms have passed, so will not come to school at least today. I will follow up with the office.
No
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Pmfs1780.org.
Report Abuse
Forms
